Not sure how Obamacare affects your health care plans in California? Obama Care California. CA Health Exchange. Covered California. Income Guidelines. Covered California Income Limits. Online Services. Covered California Website. Don't take our word for it, See Google Reviews here. For certain markets individual and family including Covered California , that now is a huge factor since Blue Shield signed deals with these providers from on.
It's less of an issue for Employer coverage and Medicare but Shield and Kaiser still compete aggressively. This is a big shift so we need to really understand their strengths and weaknesses when comparing them against each other. Individual Small and Large Business Senior. Before we jump into their very different models, let's look at their footprint in California. Total Market: Kaiser - 6. We'll go into why this is true for each market segment since it's different for each one but a quick comparison for these categories:.
It's important to run your specific growth based on that info to see if Kaiser or Blue Shield is priced best. Some aspects flow from being an HMO while others flow from Kaiser's unique take on the model owning the care providers themselves. As we mentioned, a net result of Kaiser's structure is pricing that's really hard to beat. Some of the narrow network HMO's from Shield compete but Kaiser is usually the pricing leader in a given area. With Kaiser, many members like the fact that everything is in one location.
They don't have to bounce from doctor to doctor. Tied in with this is the fact that Kaiser is able to coordinate health care among different doctors, labs, etc. With an HMO, the insurer and provider Kaiser is both in our situation have a financial incentive to manage care. There's no other way to put it. We can couch it in language to make it sound better but let's break things down and be direct.
Let's say someone has severe knee pain. Very common these days 30 years of basketball is not helping my situation. If the knee pain is significant and the result of loss of "padding" menisicus, etc, there are different paths to take. They may involve anti-inflamation pain medications, physical therapy, orthoscopic surgery, all the way up to full-knee replacement. There's an argument that doctors are too quick to jump to surgery.
We see it all the time think prostate surgeries. There are situations where an HMO might be too slow to move to a course of treatment that is needed or will not go there at all. Let's look at their pro's and con's and then we'll jump into the individual market segments.
So Blue Shield's big difference for HMO versus Kaiser is that they contract with independent hospitals, doctors, and medical groups. Let's jump into the 3 separate markets as there are differences in each between the two carriers. As we mentioned in the top level comparison between Kaiser and Blue Shield, this is really the big difference aside from price.
Do you want to see doctors outside of Kaiser or do you want to use Kaiser facilities? If you want more control over healthcare decisions and more flexibility for where and what is the course of treatment, that favors PPO.
PPO will allow more choice and flexibility. You're not locked into an area. Decisions are generally made between you and your doctor although there are more pre-authorizations needed these days. Net net So basically, Kaiser has the mechanics down pretty good claims, records, appointments, billing, etc. The best approach is to first run your quote between the two to see how rates compare here :. Our services are free to you at or by email. Add to that the strength in certain areas Bay Area and Sacramento for example of these carriers and you have further reason to compare.
We discussed in the first section how the HMO model of Kaiser compares with Blue Shield but let's get more specific to the group health market. Kaiser is Kaiser so that's easy but Blue Shield has a range of network options available. Since Kaiser is priced much better usually, there's a cost incentive for people to go that way. You can request your Kaiser Blue Shield wrap below or ask us any questions on how it works. If they've been with Kaiser for 10 years, they'll probably get Kaiser for an Advantage plan.
Below are the highlights but you can get more info on how they're different here. Since benefits are standardized with supplements, that's really a question of pricing and Blue Shield is dominating there. We explain which states have Cigna Advantage plans, how to find one, costs, and more. Amerigroup offers a total of seven different Medicare Advantage plans in seven states. Cigna Medicare Advantage does cover dental. Learn more about the dental services provided by Cigna's Medicare Advantage dental coverage.
Find out what coverage they offer, how the plans work, and how…. There's more outreach to help people sign up during the Obamacare enrollment period that began November 1. Enrollment is open until January When you have a chronic health condition, managing your health can feel like a full-time job — and with insurance considerations thrown into the mix….
Health savings accounts are a tax-free option to help pay medical expenses. We explain how they work, how to set one up, and how to know if it's right…. Medicaid enrollment has increased since President Joe Biden took office, and there are proposals for programs for new mothers and prison inmates.
In , many insurance companies are expected to the drop cost-sharing waivers previously adopted to help patients pay for vital COVID care…. Despite cutting-edge technology and government overspending, the U. And in this respect, smaller carriers like Kaiser Permanente can more than hold their own against the big boys. When it comes to quality, there is no second-guessing Kaiser Permanente Medicare plans. Every year, Medicare evaluates plans on a 5-star rating system.
Kaiser Medicare Advantage plans earned a perfect five-star rating for its Medicare Advantage plans in all states where they sell plans, except for Washington state, where Kaiser plans earned a rating of 4. This type of managed care is popular with beneficiaries who like to have their care coordinated within a network by a primary care physician. Some Kaiser Medicare Advantage plans include coverage for prescription drugs, dental, vision and hearing care.
In certain locations, some or all of these benefits may require a small additional monthly premium to have them added to your plan. Kaiser Permanente is popular among Medicare beneficiaries, thanks to its unique business model and reputation for high-quality plans.
Kaiser Permanente is a well-established insurance company that dates back to and today serves around 12 million members.
Kaiser has a unique business model in that the company is both a health insurance provider and health care provider. Members of Kaiser Medicare plans may visit a Kaiser Permanente hospital or medical facility when they use their coverage. Blue Cross Blue Shield might be the most recognizable name in the insurance industry.
0コメント